Adverse impact of multiple separations or loss of primary caregivers on young children

Figures & data

Table 1. Frequencies of separation/loss, violence exposure, and non-interpersonal trauma events.

	N	%
Non-interpersonal Trauma
Serious accidental fall	12	4.9
Accidental burn	16	6.5
Vehicular accident	4	1.6
Poisoning	4	1.6
Near drowning	2	0.8
Animal attack	1	0.4
Natural disaster or Fire	2	0.8
Total Number of Types of Non-interpersonal Trauma
0	211	85.8
1	29	11.8
2	6	2.4
Interpersonal Violence
Witnessed violence	29	11.8
Physical violence/abuse or sexual abuse	6	2.4
Total Number of Types of Interpersonal Violence
0	214	87.0
1	29	11.8
2	3	1.2
Separation/loss in the Full Sample
Caregiver separation (separated from parent ≥1 week or parent hospitalized for > 24 hours)	81	32.9
Death of loved one	38	14.1
Separation/divorce	26	10.6
Other separation/loss (caregiver or other loved one moved without further contact)	9	3.7
‘Any’ prolonged loss/separation (death, separation/divorce, other)	63	25.6
Total Number of Types of Separation/Loss in the Full Sample
0	133	54.1
1	76	30.9
2	34	13.8
3	3	1.2
Separation/loss in the Single Occurrence Group (N = 76)
Caregiver separation	50	65.8
Death of loved one	15	19.7
Separation/divorce	8	10.5
Other separation/loss	3	4.0
‘Any’ prolonged separation/loss (death, separation/divorce, other)	26	34.2
Separation/loss in the multiple occurrence group (N = 37)
Caregiver separation	31	83.8
Death of adult loved one	22	59.5
Separation/divorce	18	48.7
Other separation/loss	6	16.2
‘Any’ prolonged separation/loss (death, separation/divorce, other)	37	100.0

Table 2. Correlations among study variables.

	Demographics			Exposures				ITSEA Trauma				RAD Symptoms		FLIS Impairment
	Sex	Min	Pov	Loss	Viol	Harsh Parent	Non-Int.	Total	Re- exp	Ars	Avoid	RAD Inhib	RAD Disinh	Total	Child care	Family	Parent
Age (older)	.13*	.02	.05	.24***	.12	.03	.08	.06	.12	.02	.03	.07	.18***	.10	.06	.07	.10
Sex (male)		.01	.04	.03	.01	.04	.06	.03	−.11	.06	.12	.07	.09	.03	.00	−.01	.08
Minority			.45****	.09	.16*	−.08	.02	.04	.01	.01	.10	−.06	−.02	.10	.14*	.10	.00
Poverty				.09	.29****	−.07	.07	.24****	.16*	.20**	.24****	.02	−.05	.20**	.21***	.26****	.03
Loss					.39****	.03	.06	.21**	.24****	.19**	.06	.13*	.03	.17**	.15*	.12	.14*
Violence						.08	.15*	.26****	.22***	.23***	.15*	.13*	.09	.12	.13*	.12	.03
Harsh Parenting							.08	.26****	.05	.31****	.23***	.15*	.16*	.21**	.00	.13*	.36****
Non-int. Trauma								.15*	.16*	.07	.15*	.12	.02	.06	.04	.00	.10
Total Trauma Sx									.73****	.87****	.77****	.41****	.20**	.47****	.37****	.46****	.30****
Re-experiencing										.45****	.32****	.18**	.05	.19**	.18**	.11	.17**
Arousal											.58****	.42****	.21***	.53****	.39****	.38****	.50****
Avoidance												.37****	.20**	.37****	.28****	.36****	.25***
RAD Inhibited													.40****	.29****	.23***	.20***	.25****
RAD Disinhibited														.27****	.19**	.27****	.21**
Total Impairment															.85****	.80****	.76****
Childcare Impairment																.60****	.42****
Family Impairment																	.37****
N	246	246	246	246	246	246	246	246	246	246	246	245	245	241	241	241	241
MN (SD)	.67 (.47)	.55 (.50)	.43 (.49)	.61 (.74)	.13 (.34)	2.32 (.81)	.14 (.35)	.41 (.23)	.38 (.26)	.65 (.35)	.21 (.24)	.31 (.79)	.12 (.45)	.34 (.37)	.38 (.47)	.26 (.42)	.38 (.48)

Non-Int. Trauma = non-interpersonal trauma exposure, Re-exp = re-experiencing symptoms, Ars = Arousal symptoms, RAD = Reactive Attachment Disorder.

*p < .05, **p < .01, ***p < .001, ****p < .0001.

Table 3. Psychiatric disorders linked with multiple separations/losses.

	Adjusted Odds Ratios (95% Confidence Interval)
Independent Variables	Any Disorder	Any Externalizing	Disruptive Behavior Disorders	Any Internalizing
Child age	1.06 (1.01–1.12)	1.06 (1.00–1.12)	1.06 (0.99–1.12)	1.03 (0.97–1.10)
Child sex	2.47 (1.07–5.70)	2.67 (1.10–6.47)	2.58 (0.99–6.70)	1.85 (0.69–4.90)
Poverty	1.64 (0.84–3.22)	1.61 (0.80–3.27)	2.40 (1.11–5.17)	0.98 (0.43–2.21)
Non-interpers. Trauma	-	-	-	-
Violence/Harsh Parenting	2.49 (1.01–6.22)	2.19 (0.89–5.37)	2.01 (0.79–5.13)	2.34 (0.87–6.33)
Single Separation/Loss	1.50 (0.72–3.17)	1.39 (0.63–3.07)	1.38 (0.58–3.29)	1.58 (0.63–3.96)
Multiple Separations/Losses	2.61 (1.01–6.75)	2.40 (0.91–6.31)	3.33 (1.21–9.16)	2.32 (0.77–6.99)

For ease of interpretation, significant effects are bolded. Child age and sex were included in all models. For parsimony, models included non-interpersonal trauma only when a significant bivariate association with the outcome was present. Violence/Harsh Parenting variable was positive if violent interpersonal trauma was reported or the child experienced very harsh parenting incorporating physical and/or verbal aggression.

Figure 1. Multiple separations/losses associated with trauma symptoms and impairment.

(a) Total Trauma Symptoms, Arousal, and Re-experiencing were significantly higher in the multiple separations/losses group than the none group. This group also had higher Total Symptoms and Arousal than the single separation/loss group. Means are adjusted for age, sex, poverty, violence exposure, harsh parenting, and non-interpersonal trauma. Pairwise comparisons significant at p < .05 with Bonferroni correction. Means that share the same letter do not differ.(b) Total Impairment, Childcare Impairment and Parent Impairment were significantly higher in the multiple separations/losses group than the none group. This group also had significantly higher Childcare Impairment than the single separation/loss group. Means presented are adjusted for age, sex, poverty, violence exposure, harsh parenting, and non-interpersonal trauma. Pairwise comparisons significant at p < .05 with Bonferroni correction. Means that share the same letter do not differ.

Figure 2. Psychiatric disorders by separation/loss group.

Separation/loss group was significantly related to presence of any disorder, externalizing disorders, disruptive behavior disorders, and internalizing disorders (Χ2 = 7.42 to 13.66, p = .0064 to .0005). There also was a modest association with anxiety disorders (Χ2 = 5.19, p = .0228) but no significant association with ADHD or depressive disorders (Χ2 = 0.59 to 2.37, ns). In pairwise tests, children with multiple separations/losses were significantly more likely than children with no separation/loss to have any disorder, externalizing disorders, DBDs, and internalizing disorders (p < .05 to p < .005). Any disorder, externalizing disorders, and DBDs were also more common in children with multiple losses/separations compared to those in the single separation/loss group (p < .05). Means that share the same letter do not differ significantly.